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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601460
Report Date: 03/13/2025
Date Signed: 03/13/2025 12:54:21 PM

Document Has Been Signed on 03/13/2025 12:54 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:ALPHA OMEGAFACILITY NUMBER:
198601460
ADMINISTRATOR/
DIRECTOR:
HARRIS, YAOUNDEFACILITY TYPE:
735
ADDRESS:1911 W 41ST STTELEPHONE:
(323) 815-1134
CITY:LOS ANGELESSTATE: CAZIP CODE:
90062
CAPACITY: 4TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
03/13/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:31 AM
MET WITH:Ashawne Garrett, Direct Support TIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 3/13/25, Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Yaounde Harris, and the purpose of today’s visit was explained. The facility is licensed to operate for (4) ambulatory developmentally disabled adults ages 18 through 59. Currently, the home has (2) clients. The clients are Harbor Regional Center clients. None the clients have Restricted Health Care Conditions, and none are utilizing postural supports or protective devices.

The facility is a one family home located in a residential neighborhood. The property consists of the following: 3 client bedrooms, 2 common bathrooms, living room, kitchen, dining room, detached garage laundry room and an outdoor shaded area.

LPA conducted a records review of (2) client records, (5) staff records, (2) clients Personal & Incidental Records and reviewed the facility disaster plan. All client & Staff records were complete. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (2) Client Medication Administration Records and did not observe any discrepancies at the time of visit.

At 11:30am LPA and (Employee name) toured the inside and outside of the facility. All client rooms were checked. Mattresses and box springs were in good condition, adequate lighting was observed, plenty of dresser and closet space was observed. Walls and floors were clean and in good repair. Bed linens, comforters and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulation. Toilets and water faucets worked properly. Shower was free of mold/mildew, there is adequate lighting, and sufficient toiletries accessible to clients. The water temperature measured at 117F.

Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Carbon monoxide detector was observed and operational. Smoke detectors were working properly, fire extinguishers were fully charged, toxins and knifes were locked and inaccessible to clients. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. Outside grounds were toured and no bodies of water were observed. Exits/ Walkways around the home were free of debris and hazards

During todays visit LPA did not observe any deficiencies.

Exit interview conducted with Yaounde Harris, Administrator.

Janae HammondTELEPHONE: (424) 544-1027
Sparkle DayTELEPHONE: (424) 544-1075
DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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